Multi-dimensional mismatch and barriers for promoting PrEP among men who have sex with men in China: a cross sectional survey from the Demand-side

Abstract Men who have sex with men (MSM) is a key population for preventing HIV in China, yet Pre-Exposure Prophylaxis (PrEP) is not widely accepted in this population. An online questionnaire survey was conducted from December 2018 to January 2019. Among 1915 MSM from 34 geographical regions of China, 512 (26.7%) versus 1617 (84.4%) had an objective or subjective need of PrEP, respectively. One hundred and six (5.5%) reported affordability and only 23 (1.2%) had ever taken it. A wide disconnect exists among the objective need, willingness, affordability and uptake of PrEP. Age, living alone and occupation were associated with the objective needs. Education, occupation, sexual behavior were associated with the willingness. Age, income, sexual behavior were associated with actual usage. Cost was the most prevalent barrier, accounting for 78.22% of individuals who needed and wished for PrEP but finally failed to receive it. The findings might facilitate optimizing future allocation of resources to better promote PrEP in Chinese MSM.